探究凉血消风汤治疗血热兼风证型银屑病的证型方剂特点和临床运用研究进展.现代银屑病患者的病机特点多为内有血热、外受风邪所致的表里同病,凉血消风汤既可疏风止痒,驱散表邪,又能清热凉血,肃清内热,调和气血阴阳,起到内外兼治的作用,故可用于治疗血热兼风证型的银屑病.辨证运用凉血消风汤治疗银屑病,可为皮肤科临床诊治工作提供理论依据和实践经验.

目的 探索皮秒激光联合酶面膜对黄褐斑治疗的有效性和安全性.方法 前瞻性选取首都医科大学附属北京友谊医院门诊招募的40例黄褐斑患者作为研究对象进行研究,将患者按照1:1原则随机分为试验组和对照组各20例.试验组为皮秒激光联合酶面膜治疗,每4周进行一次皮秒激光治疗,共治疗3次,酶面膜治疗每2周1次,共治疗6次.对照组皮秒激光治疗同前,术后医用保湿面膜外敷,末次治疗后1月进行随访.对两组治疗前后的改良黄褐斑面积和严重指数(mMASI)评分、医生整体评价(PGA)评分、患者满意度、黄褐斑生活质量指数量表(MelasQoL)评分及相关评分组间改善率进行统计学分析,并记录相关不良反应.结果 试验组随访时mMASI评分为[2.80(1.88,3.83)]分,较治疗前[(5.28±1.74)分]下降,对照组随访时mMASI评分为[3.00(2.70,4.35)]分,评分较治疗前[(5.34±1.55)分]下降,差异均有统计学意义(P<0.05);试验组改善率为(42.01±16.64)％,优于对照组[(32.95±10.64)％],差异有统计学意义(P<0.05).两组间PGA评分差异无统计学意义(P>0.05).试验组满意度方面试验组优于对照组,差异有统计学意义(P<0.05).试验组随访时MelasQoL评分为[19.50(15.25,34.75)]分,较治疗前[(36.75±15.20)分]下降,对照组随访时MelasQoL评分为(29.10±11.34)分,较治疗前[(34.85±12.88)分]下降,差异均有统计学意义(P<0.05);随访时试验组MelasQoL评分改善率为33.33％,优于对照组(15.34％),差异有统计学意义(P<0.05).治疗中均未发现严重不良反应.结论 皮秒激光联合酶面膜对黄褐斑的治疗有效率及满意度高,安全性好,对于MelasQoL评分及mMASI评分改善情况尚佳,可以成为临床中黄褐斑的治疗选择之一.

目的 探索1064 nm Nd:YAG皮秒激光治疗黄褐斑的有效性和安全性.方法 前瞻性选取2019年9～10月首都医科大学附属北京友谊医院门诊招募的38例黄褐斑患者进行皮秒激光治疗,治疗共3次,每4周进行一次,随访6个月.对患者治疗前、治疗第4周、第8周、第12周及随访6个月后的改良黄褐斑面积和严重指数(mMASI)评分做出评估,记录治疗后医生整体评价(PGA)、患者疗效满意度,记录治疗及随访期间出现的不良反应情况.结果 35例患者完成本研究,Fitzpatrick皮肤分型Ⅲ型25例,FitzpatrickⅣ型10例.经过3次治疗后,治疗区域mMASI评分由治疗前的5.4(2.4,10.8)分降至2.4(0.9,4.2)分,差异有统计学意义(P<0.001).总有效率为94.3％,显效20例(57.1％),好转13例(37.1％),无效2例(5.7％).经过3次治疗后,FitzpatrickⅢ型患者mMASI评分由治疗前4.2(2.0,7.0)分降至1.5(0.9,2.6)分,FitzpatrickⅣ型患者mMASI评分由治疗前11.4(6.8,15.1)分降至4.8(3.6,6.3)分,治疗前后FitzpatrickⅢ与FitzpatrickⅣ型患者mMASI评分下降值比较,差异无统计学意义(P>0.05).FitzpatrickⅢ型患者有效率(96.0％)和FitzpatrickⅣ型患者(90.0％)比较,差异无统计学意义(P>0.05).33例(94.3％)患者PGA评分有不同程度改善,FitzpatrickⅢ型总改善率为96.0％,FitzpatrickⅣ型总改善率为90.0％.2组患者PGA评分值比较,差异无统计学意义(P>0.05).患者疗效满意率为85.7％.治疗期间未观察到严重不良反应.随访6个月后,9例(25.7％)出现复发.结论 1064 nm Nd:YAG皮秒激光治疗FitzpatrickⅢ型与Ⅳ型黄褐斑疗效均较好,不良反应小,值得临床推广应用.

Yanyan Deng Jia Li Gaoyun Yang 1Department of Dermatology, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, People’s Republic of China; 2Department of Dermatology, The Second People's Hospital of Changzhi, Changzhi 046000, People's Republic of China; 3Department of Dermatology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan 030009, People’s Republic of China Purpose: 308-nm excimer laser has a confirmed treatment effect on vitiligo. Platelet-rich plasma (PRP) is an autologous preparation which contains a variety of growth factors. The effect of 308-nm excimer laser combined with PRP on vitiligo has been rarely reported. This study investigated the effect of PRP combined with 308-nm excimer laser on stable vitiligo. Patients and Methods: A total of 60 patients with localized stable vitiligo who received treatment at Beijing Friendship Hospital and Xi’an Vitiligo Specialist Hospital between May 2019 and January 2020 were consecutively enrolled. They were equally randomized into three groups according to different treatment methods: intradermal PRP injection (group I), 308-nm excimer laser alone (group II), and 308-nm excimer laser plus PRP injection (group III). All treatments lasted for 3 months. At 3 months after treatment, clinical assessments were performed in terms of the visual analogue scale (VAS) score, repigmentation response and side effects. Results: The VAS scores showed significant differences among the three groups (P<0.001), with the highest score in group III, followed by group II and then group I. Repigmentation responses also showed significant differences among the groups (P<0.001), and the best effect was observed in group III. No side effects were reported in any of the groups. Conclusion: The effect of PRP combined with 308-nm excimer laser on stable vitiligo is significantly better than that of PRP and 308-nm excimer laser alone. It is safe and satisfactorily tolerant.

PURPOSE:308-nm excimer laser has a confirmed treatment effect on vitiligo. Platelet-rich plasma (PRP) is an autologous preparation which contains a variety of growth factors. The effect of 308-nm excimer laser combined with PRP on vitiligo has been rarely reported. This study investigated the effect of PRP combined with 308-nm excimer laser on stable vitiligo. PATIENTS AND METHODS:A total of 60 patients with localized stable vitiligo who received treatment at Beijing Friendship Hospital and Xi'an Vitiligo Specialist Hospital between May 2019 and January 2020 were consecutively enrolled. They were equally randomized into three groups according to different treatment methods: intradermal PRP injection (group I), 308-nm excimer laser alone (group II), and 308-nm excimer laser plus PRP injection (group III). All treatments lasted for 3 months. At 3 months after treatment, clinical assessments were performed in terms of the visual analogue scale (VAS) score, repigmentation response and side effects. RESULTS:The VAS scores showed significant differences among the three groups (P<0.001), with the highest score in group III, followed by group II and then group I. Repigmentation responses also showed significant differences among the groups (P<0.001), and the best effect was observed in group III. No side effects were reported in any of the groups. CONCLUSION:The effect of PRP combined with 308-nm excimer laser on stable vitiligo is significantly better than that of PRP and 308-nm excimer laser alone. It is safe and satisfactorily tolerant.

目的 分析富血小板血浆(PRP)联合外用米诺地尔酊治疗雄激素性秃发的疗效.方法 前瞻性选取2019年7～8月首都医科大学附属北京友谊医院收治的雄激素性脱发患者32例作为研究对象进行病例对照研究,根据随机数字表法将患者分为观察组16例和和对照组16例,观察组患者予以PRP皮下注射联合外用米诺地尔酊治疗,对照组患者予以皮下注射生理盐水联合外用米诺地尔酊治疗.比较两组患者治疗前后毛发密度、毛发增加数量、临床疗效及不良反应发生情况.结果 对照组患者失访2例.观察组和对照组患者治疗后毛发密度均有所增加,但观察组增加更显著,差异具有统计学意义(t=-7.80,P<0.05);观察组和对照组患者毛发增加数量(根/1.28 cm2)为21.50(11.25,34.50)vs.5.00(-1.00,6.25),两组比较,差异具有统计学意义(U=3.500,P<0.05);观察组治疗总有效率93.75％高于对照组50.00％,差异具有统计学意义(χ2=7.308,P=0.012);两组患者治疗过程中均无不良反应发生.结论 PRP联合外用米诺地尔酊治疗雄激素性秃发毛发数量增加明显,治疗有效率高,值得临床进一步探究.

目的 观察自体富血小板血浆(PRP)皮内微针注射联合308 nm准分子激光治疗稳定期白癜风的临床效果.方法 选取2017年2月至2018年2月首都医科大学附属北京友谊医院及白癜风专科医院接诊和募集的稳定期白癜风患者40例进行前瞻性自身对照研究.40例患者的对称部位或相近部位有2片单独的稳定皮损,共得80片皮损,左侧或上部为观察组,右侧或下部为对照组,每组各40片皮损.所有患者皮损均予他克莫司软膏每日1次外用,308 nm准分子激光照射治疗,每周2次,观察组另外给予自体PRP 3周1次皮内微针注射,对照组另外给予安慰剂注射,每次注射前测量皮损面积,连续治疗3个月后评价皮损复色面积、显效率和皮损治疗中的不良反应.结果 ①40例患者均完成了治疗周期,观察组患者白斑面积治疗前为(14.18±1.88)cm2,治疗后为(5.00±2.43)cm2,差异具有统计学意义(P<0.05).对照组患者白斑面积治疗前为(13.27±1.57)cm2,治疗后为(6.36±2.83)cm2,差异具有统计学意义(P<0.05).观察组平均复色面积为(19.19±2.70)cm2,对照组平均复色面积为(6.92±2.94)cm2,两组平均复色面积比较,观察组患者白斑面积变化较对照组显著,差异具有统计学意义(t=3.606,P<0.05).②观察组患者显效率为77.50％;对照组患者显效率为52.50％.观察组显效率明显高于对照组,差异具有统计学意义(χ2=5.49,P<0.05).③观察组面颈部显效率为84.61％(11/13),躯干部显效率为86.67％(13/15),四肢部显效率为71.43％(5/7),肢端部显效率为40.00％(2/5).结论 自体PRP皮内微针注射治疗白癜风是一种安全、有效的疗法,与308 nm准分子激光联合治疗可有效提高白斑复色率,缩短治疗时间,避免长期308 nm准分子激光照射的不良反应.

白癜风是一种常见的自身免疫性疾病,其对患者面容的损坏严重伤害了患者的自尊心,影响患者的生活质量[1,2].综合来说,白癜风的发生是遗传因素和环境因素相互作用引起皮肤黑素细胞被自身免疫系统攻击损伤造成的结果 .目前白癜风的治疗方法 虽然较多,但其疗效常常欠佳,且很多治疗方法 缺乏循证医学的证据.近年来随着对白癜风发病机制的探索不断深入,一些新的治疗靶位的发现,使得白癜风的治疗方向与方法 得到发展.

注射治疗是面部年轻化的重要手段,根据注射目的和要求不同,可选择的注射药品和注射方法多种多样,注射疗效的观察和判定也各有不同.面部皱纹年轻化注射治疗可以通过皱纹形态变化和WSRS量表等来观察和评价,面部轮廓年轻化注射治疗可以直接观察或通过3D测量方法对注射前后面部轮廓变化进行比较,面部皮肤年轻化注射可以直接观察,也可借助VISIA等仪器检测皮肤纹理、皱纹、毛孔、色素等的变化来评价,病人的满意程度也是重要的疗效判定内容.

痤疮为常见损容性、慢性炎症性皮肤病,青春期多发,往往对青少年的学习和心理造成不同程度的影响.痤疮的发生机制多为青春期皮脂腺分泌旺盛,毛囊皮脂腺导管开口处过度角化导致皮脂排出受阻,以及痤疮丙酸杆菌过度繁殖导致的慢性炎症反应,表现为局部皮肤粉刺、丘疹、囊肿或者结节样皮损.痤疮的临床治疗主要包括局部外用或口服抗生素、维A酸,局部外用水杨酸以及各种激光设备及手术[1].但由于细菌耐药性逐渐增加、系统药物副作用较大,安全有效的物理疗法成为治疗痤疮的新趋势.光动力疗法(photodynamic thera-py,PDT)是一种具有高选择性的药械联用技术,广泛应用于皮肤科炎症性、传染性、癌症及癌前病变等多种皮肤科疾病的治疗,是局部外用治疗皮肤科疾病的一项新型诊疗技术.近年来,随着光动力疗法应用的不断更新和发展,临床对光动力疗法在痤疮治疗中的认识和研究也在不断丰富.现将PDT治疗原理、治疗参数的选择、疗效及不良反应的研究进展综述如下.

Objective To observe the clinical effect of external use of imiquimod combined with ozone oil after laser operation of condylo-ma acuminatum. Methods Sixty condyloma acuminatum patients were retrospectively analyzed from Feb 2017 to May 2018 and were randomly di-vided into two groups with 30 patients in each group. The treatment group was treated with CO2laser for external use of imiquimod combined with ozone oil and the control group was treated by CO2laser therapy with imiquimod combined with ciprofloxacin gel. They were followed up at 2 weeks and 4 weeks after operation,and the wound healing and condyloma acuminatum recurrence circumstance were recorded. Results The wound healing rate was 86.7% in treatment group,which was higher than that of the control group 60.0%,the difference was statistically significant (P ＜0.05);and the recurrence rate 30.0% in treatment group was lower than that of the control group 56.7% with statistically significant difference (P ＜0.05). Conclusion External use of imiquimod combined with ozone oil after laser operation of condyloma acuminatum is effec-tive. It was good for mucosal wound healing and can reduce recurrence rate. Therefore,it is worth for clinical practice.

Objective Through the external using chemokine- like factor 1 (CKLF1) antagonism peptides C19 topical administration, to investigate its function in the mouse model with atopic dermatitis. And to analyze the relationship between C19 concentration and the therapeutic effect of atopic dermatitis in mice. Methods The mouse models of atopic dermatitis were established by sensitizating with ovalbumin (OVA) through the skin.55 BALB/c mice were randomly divided into atopic dermatitis (AD) group, control group, prevention group and treatment group a, b and c, 11 mice in each group. The control group and dermatitis group were treated with topical 0.9％ sodium chloride treatment. The treatment groups (a, b and c) were treated with C19 topical application of 0.1 μg/ml, 1.0 μg/ml and 10.0 μg/ml, respectively. At the end of treatment, the lesions of mice in each group were observed and recorded. The lesions and serum of mice were collected and the histopathological changes, the related inflammatory factors and the serum total IgE level were observed. Results ①Compared with the blank control group,dermatitis group and the treatment group showed obvious edema, erythema, exudation, dander, scab and other skin rash on the local skin of the mice. The modeling was successful.②After treatment, local skin appearance and histopathological inflammation of AD mice were alleviated after local topical treatment with C19. Compared with dermatitis group, inflammatory factors IL-4 and IL-5 in tissue homogenate were significantly decreased in treatment group c (P ＜0.05), while there was no significant difference between the treated group and the dermatitis group (P ＞0.05). Compared with the dermatitis group, the levels of inflammatory cytokines IL (P ＜0.05), while IL- 13 and Eotaxin decreased significantly in treatment group a, b and c, and the difference was statistically significant. There was no significant difference in a, b and c groups (P ＞0.05). Conclusion CKLF1 antagonist peptide C19 can play a therapeutic role in skin- specific absorption in mouse- specific dermatitis model. The effect of high concentration C19 in serum IgE and tissue homogenate IL-4 and IL-5 is better than that of low concentration C19. In Eotaxin and IL- 13, its therapeutic effect has no concentration dependence.

目的 探讨趋化素样因子1(CKLF1)及其拮抗肽C19对不同时期特应性皮炎(AD)患者外周血T细胞亚群的作用.方法 应用淋巴细胞分离液分离急性期和慢性期AD的外周血单个核细胞(PB-MC),运用流式细胞术(FACS)检测CKLF1在其外周血T细胞亚群中的表达,并与正常对照组比较;体外诱导培养AD患者的Th1,Th2细胞亚群,以不同浓度CKLF1和(或)C19刺激上述细胞,并采用酶联免疫吸附法(ELISA)检测培养上清中IFN-γ,IL-4,IL-17水平变化.结果 急性期AD患者Th2细胞中CKLF1的表达高于对照组(P＜0.05),慢性期AD患者Th1细胞中CKLF1的表达高于对照组(P＜0.05).AD患者外周血CKLF1在Th17细胞中表达与正常对照组间差异无统计学意义.急性期AD患者体外培养的Th2细胞产生的IL-4水平高于对照组(P＜0.05),慢性期AD患者体外培养的Th1细胞产生的IFN-γ水平高于对照组(P＜0.05).IL-17在急性期和慢性期AD患者体外培养的Th1细胞中的水平与正常对照组相比差异均无统计学意义.急性期AD患者的Th2细胞经CK-LF1刺激,产生IL-4水平高于未刺激组(P＜0.05).经CKLF1和C19(10ng/mL)共同培养后,IL-4的水平降低.慢性期AD患者的Th1细胞经CKLF1刺激,产生IFN-γ的水平高于未刺激组(P＜0.05).经CKLF1和C19(10ng/mL)共同培养后,IFN-γ的水平无显著改变.结论 CKLF1在AD患者发病中可能起着重要的病理性作用,CKLF1的拮抗肽C19可能对急性期AD患者具有潜在治疗作用.

目的:检测1800例变态反应性皮肤病患者血清过敏原及总IgE,筛查本地区常见过敏原.方法:采用德国Allergy Screen变应原定量免疫印迹法检测血清过敏原及总IgE.结果:750例(41.67%)患者过敏原阳性.吸入组以粉尘螨/户尘螨最高(338例,18.78%);食入组过敏原以牛羊肉最高(87例,4.83%);总IgE水平>100 IU/mL者占1253例(69.61%).结论:北京地区过敏原结果与相关文献报道差异性较大,有必要根据本地区实际情况确定过敏原筛查范围.

Objective To explore the function of chemokine-like factor 1(CKLF1)antagonism peptides C19 in mouse model with atop-ic dermatitis. Methods The mouse model of atopic dermatitis were established by sensitization with ovalbumin( OVA)through the skin. 60 BALB/c mice were randomly divided into atopic dermatitis( AD)group,control group,prevention group,and treatment group,15 mice in each group. The gene expression profile of micro RNA in total RNA of every groups by ULSTM fluorescence detection calibration was detected. Results①The AD group showed local inflammation in the skin compared with the control group and prevention group. Epidermal thickening and signifi-cant inflammatory cellular infiltration were observed and the skin lesion of treatment group mice improved after 2 times treatment with C19. ② In order to detect the gene expression profile of micro RNA in total RNA of every groups by ULSTM fluorescence detection calibration,the data indi-cates that the expression level of micro RNA which regulate the specific gene of inflammatory cytokines in the lesions. The gene was up-regulated after treatment or prevention with C19. Conclusion Prevention or treatment with the CKLF1 antagonism peptides C19 may play an important ther-apeutic role in atopic dermatitis. Further study about the peptide may contribute to better understanding and exploring new anti-inflammatory medicine for the treatment of atopic dermatitis.

Facial flat wart, caused by human papilloma virus type 3 and less often, type 10, 27, and 41, often brings many cosmetic problems to children and young adults. Considering the disturbing cosmetic problem, the treatment of facial flat wart is always frustrating and often unsuccessful, although there are many treatment modalities. Considering the possible serious side effects of 5-aminolevulinic acid photodynamic therapy (ALA-PDT), we designed step-up therapy of ALA-PDT on different clinical phases of facial flat wart. As a new protocol of ALA-PDT, we found the step-up therapy of ALA-PDT could also receive excellent effects with the lower side effects. Meanwhile, the tolerance of patients to ALA-PDT could improve with subsequent treatment sessions and escalating doses of ALA-PDT.

临床资料<br>　　例1，女，4岁。主因头皮异物2 d，于2012年6月23日就诊。患者于就诊前2 d在草地上玩耍后发现头皮有一小米粒大小的异物，褐黑色，无自觉症状。异物逐渐增大，于外院诊断蜱叮咬，建议外科局部切除治疗，患儿家属拒绝。自行用艾草烟熏治疗无效，异物增大至绿豆大小，伴轻微瘙痒及疼痛。系统查体未见明显异常。皮肤科情况：头皮顶部可见一褐黑色约0.6 cm×0.8 cm大小的卵圆形虫体，虫体头部嵌入皮肤，周围皮肤有红晕（图1a），触痛。实验室检查：血常规及肝肾功能均正常。诊断：蜱叮咬。治疗：用甘油及莫匹罗星软膏外敷10 min后，用镊子夹住虫体，轻轻外拔，无松动感；继续甘油及莫匹罗星软膏外敷20 min后，沿蜱体喙器刺入方向取出一完整虫体，外用百多邦，每日3～5次。随访1个月无不适。

Epidemiological studies have shown that cigarette smoke (CS), a very common environmental factor, plays an important role in skin aging.Although some in vivo studies have suggested that CS affects skin aging, the detailed effects of CS on skin cells in vitro remain largely unknown.In this study, we investigated the effects of cigarette smoke extract (CSE) on the growth, proliferation, and senescene of skin fibroblasts and the possible mechanism underlying these effects.Primary cultured human fibroblasts were exposed to a range of concentrations of CSE.Cell viability and cell proliferation after CSE exposure were analyzed with the methyl thiazolyl tetrazolium (MTT) assay and bromodeoxyuridine incorporation assay, respectively.Growth curves of fibroblasts exposed to different concentrations of CSE were developed and prolonged CSE-exposed cells were observed.Morphological and ultrastructural changes in fibroblasts were assessed by inverted light microscopy and transmission electron microscopy (TEM).Dying cells were stained with senescence-associated β-galactosidase (SA β-gal).Intracellular reactive oxygen species (ROS) levels, superoxide dismutase (SOD) activity, and glutathione peroxidase (GSH-Px) activity were determined by a colorimetric method.We found that proliferative capacity and growth were inhibited by CSE exposure in a dose-and time-dependent manner.Fibroblasts exposed to even low concentrations of CSE for a long period of time (5 passages) showed significantly increased SA β-gal activity and typical features of aging cells.Meanwhile, CSE inhibited superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities and augmented ROS levels.Our observations suggest that CSE exposure impairs fibroblast growth and proliferation and leads to features similar to those seen in senescent cells.Oxidative stress injury and inhibition of antioxidant defense activity may be involved in CSE-induced fibroblast senescence.

<正>趋化因子家族是一类由免疫或非免疫细胞分泌的一级结构相似的小分子蛋白,在机体的免疫调节、过敏反应、炎症反应、细胞增殖分化等过程中发挥重要作用。趋化因子超家族成员具有一定的同源结构,根据一级结构中保守的4～6个Cys的前2个Cys的排列方式,可将趋化因子超家族分为CXC(α)、CC(β)、C(γ)和CX3C()四个亚家族,它们的功能除趋化活性外,还具有细胞活化等多种生物学效应。这些趋化因子与七次跨膜的G

<正>研究生教育承担着培养创新人才和各层次专门人才的重任,是国家培养高层次人才的主要方式,也是我国高等教育的重要环节。研究生的教育水平和培养质量已成为研究型大学确立学术地位的重要标志之一。研究生的教学方式与本科生不同,除了课堂教学以外,更重要的是强化对研究生创新能力和科研协作能力的培养,研究生教育区别于其它层次教育的最为显著的特点就是把科学研究引入到教学过程[1]。如何提高研究